title: Embolization for non-variceal upper gastrointestinal tract haemorrhage: a systematic review.
abstract: OBJECTIVE
  To assess the published evidence on the endovascular treatment of non-variceal upper gastrointestinal haemorrhage.
  
  
  METHODS
  An Ovid Medline search of published literature was performed (1966-2009). Non-English literature, experimental studies, variceal haemorrhage and case series with fewer than five patients were excluded. The search yielded 1888 abstracts. Thirty-five articles were selected for final analysis.
  
  
  RESULTS
  The total number of pooled patients was 927. The technical and clinical success of embolization ranged from 52-100% and 44-100%, respectively. The pooled mean technical/clinical success rate in primary upper gastrointestinal tract haemorrhage (PUGITH) only, trans-papillary haemorrhage (TPH) only, and mixed studies were 84%/67%, 93%/89%, and 93%/64%, respectively. Clinical outcome was adversely affected by multi-organ failure, shock, corticosteroids, transfusion, and coagulopathy. The anatomical source of haemorrhage and procedural variables did not affect the outcome. A successful embolization improved survival by 13.3 times. Retrospective comparison with surgery demonstrated equivalent mortality and clinical success, despite embolization being applied to a more elderly population with a higher prevalence of co-morbidities.
  
  
  CONCLUSIONS
  Embolization is effective in this very difficult cohort of patients with outcomes similar to surgery.
authors.affiliation: Department of Radiology, Leeds General Infirmary, Leeds, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mirsadraee
authors.forename: P
authors.initials: P
authors.lastname: Tirukonda
authors.forename: A
authors.initials: A
authors.lastname: Nicholson
authors.forename: S M
authors.initials: SM
authors.lastname: Everett
authors.forename: S J
authors.initials: SJ
authors.lastname: McPherson
mesh_terms: D004621:Embolization, Therapeutic / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods; D006801:Humans; D008297:Male; D012307:Risk Factors